Medicare Supplement Plans (Medigap)
Medicare Supplement Plans were created to supplement, or compliment, Original Medicare benefits. Original Medicare only covers 80% of your medical expenses.
Medicare Supplemental plans fill in the gap between Medicare’s payments and the actual amount billed. These gaps include co-pays, deductibles, and coinsurance.
With many policy options, the best one for you depends on the level of coverage you need.
Below we’ll review:
- Eligibility guidelines
- Enrollment periods
- How benefits work
- Available Medicare Supplement Plans
- Important facts
- How to apply
Medicare Supplement Plans
To be eligible for a Medicare Supplement Plan, you must be at least 65 years of age and enrolled in Medicare Part B. These plans are also available to those on Medicare due to a disability, but not in all states.
You can enroll in a Medicare Supplement Plan at anytime during the year, as long as your Part B is in effect.
Upon your enrollment in Medicare Part B, your Medicare Supplement Open Enrollment Period will begin. This window only occurs once and cannot be extended or changed.
Your Open Enrollment Period is six months long. During this period, you can purchase Medicare Supplement insurance with Guaranteed Issue. After this six month period, you’ll no longer have Guaranteed Issue, but you can still enroll.
However, without Guaranteed Issue you’ll have to answer medical questions that could impact your acceptance odds. You could also end up paying more due to pre-existing conditions.
If you’re over the age of 65 and don’t enroll in Part B when you’re first eligible, your OEP doesn’t start until you do enroll in Part B and it becomes effective. Important to note, if you don’t enroll in Part B when you’re first eligible, you could be penalized for each year you went without it.
The General Enrollment Period for Medicare Parts A & B is yearly between January 1st and March 31st. If you didn’t sign up during your Initial Enrollment Period, you can sign up during this time period.
How Medicare Supplement Benefits Work
Medicare Supplements coverage benefits are dependent on the letter plan you choose. These plans are standardized by the government.
The benefits are going to be the same per letter plan, regardless of the carrier. The only difference is the cost, it’s up to the carrier to decide how much they want to charge for each letter plan.
A carrier can choose between three Medigap pricing methods to determine your premium.
Each letter plan includes the basic benefits, starting with Plan A, and adds additional benefits or levels of coverage.
This way, everyone can get the individual healthcare benefits they need to cover there out of pocket medical costs not covered by Original Medicare.
It’s important to note that these plans only cover one individual. If your spouse needs coverage, they’ll be required to purchase a separate policy.
Benefits All Medicare Supplement Plans Will Include
- Remaining 20% of your Part B medical costs left over after Medicare pays their share
- Coverage for your Part A coinsurance and hospital costs up to an additional 365 days after your Original Medicare benefits have been exhausted
- Coverage for any Part B coinsurance and co-payments
- Coverage for any hospice care coinsurance and co-payments
- First 3 pints of blood
Benefits Some Medicare Supplement Plans Will Include
- Part A deductible
- Part B deductible
- Part B excess charges
- Foreign travel emergency
- Coinsurance for skilled nursing facility care
What Medicare Supplement Plans Do NOT Cover
- Routine vision care
- Routing dental care
- Prescription drugs
- Private-duty nursing
- Long Term Care
- Hearing Aids
Available Medicare Supplement Plans
The plans are listed in order from most popular to least popular:
- Plan F is a first-dollar coverage plan that leaves you with $0 out of pocket costs.
- High-deductible Plan F covers the same benefits as Plan F. The difference is it requires you to meet the deductible before any coverage starts.
- Plan G is the second most popular plan, as it covers almost all the available benefits. It comes with a much lower premium than Plan F.
- Plan N has extremely low premiums compared to other plans. It requires a small co-payment for some office and hospital visits.
- Plan C is also considered a first-dollar coverage plan. The only out of pocket cost you’re responsible for is excess charges. Don’t confused Plan C with Part C, they’re two completely different Medicare plans.
- Plan D is extensive as well and covers everything except for the Part B deductible and excess charges. Don’t confuse Plan D with Part D, they’re also two completely different Medicare Plans.
- Plan K is considered a cost sharing plan. It pays half of your out of pocket co-insurance costs.
- Plan L is also considered a cost sharing plan. It pays 75% of your out of pocket co-insurance costs.
- Plan M provides extensive coverage, similar to Plan G. Except it only covers half of your Part A deductible for hospitalization.
- Plan A helps fill in the gaps with co-payments, deductibles, and coinsurance, but includes the least amount of benefits.
- Plan B will cover all the same benefits Plan A does, in addition it will cover your Part A deductible.
Plans G, K, L, M, and N tend to have lower premiums, but higher out-of-pocket costs.
Important Facts to Know About Medicare Supplement Plans
- Medicare Supplements do NOT include coverage for prescription drugs. You would enroll in a stand-alone Medicare Part D Prescription Drug Plan to cover your prescription costs.
- Policies only provide coverage to the policyholder. If you want coverage for your spouse or family member, they will have to purchase their own policy.
- It’s only available for individuals who already have both Medicare Part A and Part B.
- By law, policies must be renewable even for individuals with health conditions. In other words, you can never lose your policy as long as you pay your monthly premiums.
- Policy premiums are in addition to any Medicare Part B premiums.
- You cannot enroll in a Medicare Supplement Plan if you have a Medicare Advantage Plan.
- It’s illegal to sell someone a policy if they have a Medicare Medical Savings Account (MSA) plan.
- All first-dollar coverage plans will be discontinued for all beneficiaries who become Medicare eligible after 2020.
- Depending on where you live, you may be eligible to purchase a certain kind of policy called Medicare SELECT. These Medicare SELECT policies provide a built-in escape clause to allow you to change your policy within the first year with no penalties.
Don’t Confuse These Types of Coverage for Medicare Supplement Plans
- Veterans’ benefits (VA)
- Tribal and/or Indian Health Service coverage
- Medicare prescription drug plans (Part D)
- State-level aid
- Medicare Advantage Plans (including HMOs, PPOs, and fee-for-service plans)
- Long-term care insurance
- Employer/union plans, including FEHBP (Federal Employees Health Benefits Program)
Medicare Supplement Costs
It’s important to note that prices and premiums vary by insurance company, as well as by state. The same exact plan may cost more in one state than another. Depending on the letter plan you choose, the average premium can range anywhere between $50-$300.
When shopping for a policy, be careful to assess “apples to apples.” In other words, make sure that the price you’ve been quoted for one type of coverage is equivalent to the same type of coverage provided by another company. Medicare beneficiaries should take their time when selecting a policy.
Get Rates for Medicare Supplement Plans Online or By Phone
Plans vary by state, talking to an expert who can help you find affordable Medicare Supplement Plans in your area will give you piece of mind.
Our representatives will help you compare rates with the top carriers in your area to find the plan that fits your unique healthcare needs and budget.
Give us a call today. If you prefer to compare rates online, you can complete our rate comparison form here.